Friday, 22 Mar 2019

You are here

Inflammatory Arthritis Variants with Checkpoint Inhibitors

Two recently published studies have demonstrated distinctive patterns of rheumatic complaints in patients treated wtih immune checkpoint inhibitors (ICIs).

Capelli and colleagues have studied patients treated with ICIs and found two variants of inflammatory arthritis (IA) - a reactive arthritis like large joint arthritis with combination ICI therapy or a small joint IA with ICI monotherapy.

Inflammatory arthritis (IA) is of several immune-related adverse event (irAE) seen with ICI therapy.

They identified 30 patients with combination ICI therapy who primarily presented with knee arthritis, with high C-reactive protein levels, a prior irAE, and show a a reactive arthritis-like phenotype.

By contrast, those treated with ICI monotherapy were more likely to have initial small joint involvement and to have IA as their only irAE.

Ten patients required additional immunosuppression beyond corticosteroids, with TNF-inhibitors and/or methotrexate. Those on TNF inhibitors did not show tumor progression.

Another French cohort study described the two rheumatic variants in 35 (6.6%) of their 524 ICI treated patients. (Citation source: https://buff.ly/2HV9msa)

All but one of the rheumatic irAEs occurred with anti-programmed cell death protein 1(PD-1)/PD-1 ligand 1(PD-L1) antibodies, with a median exposure time of 70 days.

Patients either exhibited IA that mimicked rheumatoid arthritis (n=7), polymyalgia rheumatica (n=11) or psoriatic arthritis (n=2) or they demonstrated non-inflammatory musculoskeletal conditions (2.8%; n=15).

IA patients required glucocorticoids, and methotrexate was started in two patients.

Non-inflammatory disorders were managed with non-steroidal anti-inflammatory drugs, analgesics and/or physiotherapy.

They noted that those with rheumatic irAEs had a higher tumour response rate compared with patients without irAEs (85.7% vs 35.3%; P<0.0001).

Disclosures: 
The author has no conflicts of interest to disclose related to this subject

Rheumatologists' Comments

More Like This

Best of 2018: The Safety of Paternal Exposure to DMARDs and Biologics

Pregnancy and drug safety is a complex issue, often with limited information about maternal drug exposure on the offspring. Greater uncertainty exists when considering whether paternal exposure may also influence fetal outcomes.

A systematic review examined the effect of disease modifying anti-rheumatic drugs (DMARDs) on male fertility and if peri-conception (within 3 months) paternal exposure was detrimental to fetal outcomes.

Best of 2018: Hydroxychloroquine Being Over-Dosed with New Guidelines?

Hydroxychloroquine retinopathy prevention guidelines have revised from ideal body weight-based dosing to actual body weight-based dosing; the question remains whether these have been adopted in clinical practice. A database of nearly 21,000 new HCQ users from a UK general population database studied HCQ dosing and use between 2007 and 2016. Specifically they examined whether users were subjected to excess HCQ dosing per ophthalmology guidelines (defined by exceeding 6.5 mg/kg of IBW and 5.0 mg/kg of ABW).

CDC Top 15 Most Common Opioid Overdose Drugs

The Dec. 12 issue of the National Vital Statistics Reports from the U.S. Centers for Disease Control and Prevention reports that the most commonly abused drugs causing drug overdose deaths (between 2011-2016) include fentanyl, heroin, oxycodone, and cocaine.

Trazodone High Risk of Falls and Fractures

The CMAJ (Canadian Medical Association Journal) has reported that trazadone use in the elderly may be associated with a risk of falls and major fractures. 

Using claims data from ICES, researchers compared 6588 seniors given trazadone to 2875 receiving another atypical antipsychotic.

Musculoskeletal Events with Statin Use

Analysis of the FDA Adverse Event Reporting System data examined the association between statins' musculoskeletal adverse events (MAEs).

Review of the data shows that atorvastatin and rosuvastatin (with strong low‐density lipoprotein cholesterol‐lowering effects) had a higher risk and a faster onset of MAEs when compared with simvastatin.

They could not detect whether concomitant drugs shifted the onset timing of MAEs.